What is the best approach to manage pediatric patients with mumps?

Management of Pediatric Patients with Mumps

Mumps in children requires supportive care only—no antiviral therapy exists—with strict 5-day isolation, symptom control, and vigilant monitoring for complications. 1, 2

Immediate Actions

Implement Strict Isolation

• Isolate the child immediately using droplet precautions for 5 days after parotitis onset, as patients are contagious from 7 days before through 8 days after parotid swelling begins 1, 2, 3
• Educate family members that transmission occurs through respiratory droplets and direct contact with saliva 1, 2
• Report the case immediately to state and local health departments as mumps is a notifiable disease 1

Provide Symptomatic Relief

• Administer acetaminophen or NSAIDs for fever control, headache, and parotid gland pain 1, 2
• Ensure adequate fluid intake, as parotitis makes swallowing uncomfortable and painful 1, 2
• Recommend soft foods and avoid acidic foods that stimulate salivary flow and worsen parotid pain 1

Critical Monitoring for Complications

Children generally experience milder complications than adults, but vigilant monitoring remains essential. 4, 1

Neurological Complications

• Watch for aseptic meningitis (occurs in 4-6% of cases): severe headache, neck stiffness, photophobia, or altered mental status 1, 2
• Assess for encephalitis signs including seizures, paralysis, or cranial nerve palsies—these can cause permanent sequelae 1, 2
• Monitor for sudden hearing loss, as mumps was a major cause of sensorineural deafness in children before vaccination; deafness can be bilateral and permanent 4, 1, 2

Other Complications

• In postpubertal males, assess for orchitis (testicular pain and swelling), though sterility is rare 4, 1, 2
• Watch for pancreatitis: severe abdominal pain, nausea, and vomiting 1, 2

Special Management for Facial Nerve Involvement

• If facial droop or weakness develops, initiate prednisone 1-2 mg/kg/day for 5-7 days followed by a 5-7 day taper to reduce inflammation and improve nerve function 1
• Provide eye protection to prevent corneal damage if facial weakness prevents complete eye closure 1
• Reassure families that complete recovery occurs in approximately 70-80% of cases within 3-6 months 1

Critical Clinical Caveats

Diagnostic Pitfalls

• Do not rely on parotitis alone for diagnosis—only 30-40% of mumps infections produce typical parotitis, while 15-20% are asymptomatic and up to 50% present with nonspecific or respiratory symptoms 1, 5
• Serious complications can occur without evidence of parotid swelling 4, 1
• Laboratory confirmation is preferred: mumps virus isolation, significant rise in serum mumps IgG, or positive mumps IgM antibody 1

Vaccination Context

• Suspect mumps regardless of vaccination status—since 2007,87% of pediatric mumps cases occurred in vaccinated children, with 86% of 5-17 year-olds having received ≥2 MMR doses 6
• Recent outbreaks have occurred in highly vaccinated populations, particularly among young adults in college settings 1, 7, 6
• Two-dose MMR vaccine is approximately 88% effective, meaning breakthrough infections occur 2, 7

Common Pitfalls to Avoid

• Do not assume immunity based on vaccination history alone—breakthrough infections are common 1, 6
• Do not overlook mumps in patients without parotitis—maintain high clinical suspicion with nonspecific symptoms during outbreaks 1, 5
• Do not extend isolation beyond 5 days after parotitis onset, as compliance drops significantly with longer isolation periods and evidence supports 5-day isolation 3

Expected Clinical Course

• Mumps is generally self-limiting, with most pediatric patients recovering without intervention beyond supportive care 1, 5
• Complications are significantly more common and severe in adults than children 4, 1, 5
• Only 1% of pediatric patients develop complications and 2% require hospitalization 6